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Alexander S, Langhoff-Roos J. Intra-partum care of the perineum matters: new knowledge and remaining gaps. BJOG 2021; 128:593. [PMID: 33035397 DOI: 10.1111/1471-0528.16560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/13/2020] [Accepted: 10/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
- S Alexander
- School of Public Health, Universite Libre de Bruxelles, Brussels, Belgium
| | - J Langhoff-Roos
- University of Copenhagen Faculty of Health and Medical Sciences, Rigshospitalet, Copenhagen, Denmark
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Olsen SF, Halldorsson TI, Thorne-Lyman AL, Strøm M, Gørtz S, Granstrøm C, Nielsen PH, Wohlfahrt J, Lykke JA, Langhoff-Roos J, Cohen AS, Furtado JD, Giovannucci EL, Zhou W. Corrigendum to 'Plasma concentrations of long chain N-3 fatty acids in early and mid-pregnancy and risk of early preterm birth'. EBioMedicine 2020; 51:102619. [PMID: 31927481 PMCID: PMC6956750 DOI: 10.1016/j.ebiom.2019.102619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- S F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA.
| | - T I Halldorsson
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - A L Thorne-Lyman
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA; Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - M Strøm
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Faculty of Natural and Health Sciences, University of the Faroe Islands, Torshavn, Faroe Islands
| | - S Gørtz
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - C Granstrøm
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - P H Nielsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - J Wohlfahrt
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - J A Lykke
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - J Langhoff-Roos
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - A S Cohen
- Department of Congenital Diseases, Statens Serum Institut, Copenhagen, Denmark
| | - J D Furtado
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
| | - E L Giovannucci
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | - W Zhou
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China; School of Public Health, Fudan University, Shanghai, China
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Morel O, Collins SL, Uzan-Augui J, Masselli G, Duan J, Chabot-Lecoanet AC, Braun T, Langhoff-Roos J, Soyer P, Chantraine F. A proposal for standardized magnetic resonance imaging (MRI) descriptors of abnormally invasive placenta (AIP) - From the International Society for AIP. Diagn Interv Imaging 2019; 100:319-325. [PMID: 30853416 DOI: 10.1016/j.diii.2019.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 11/29/2022]
Abstract
Abnormally invasive placenta (AIP) is used to describe a placenta that does not separate naturally after delivery and cannot be extirpated without causing abnormally high blood loss. Recently, the use of a standardized terminology for descriptors of AIP signs seen on ultrasound has been prosed but to date no such unified descriptors have been developed for magnetic resonance imaging (MRI). The purpose of this paper is to propose a unified terminology based on a consensus opinion from the members of the International Society for AIP (IS-AIP) that include obstetricians, gynecologists, radiologists, pathologists, anesthesiologists and basic science researchers. We assume that using these standardized MRI descriptors for AIP will be useful for clinical use, education, teaching and future research projects, thus assumably improving care of patients with this condition. In addition, using a uniform terminology for AIP should become the first step of a standardized MRI report.
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Affiliation(s)
- O Morel
- Department of Obstetrics & Gynecology, centre hospitalier régional universitaire de Nancy, Université de Lorraine, CIC-IT, IADI, Université de Lorraine, 54000 Nancy, France.
| | - S L Collins
- University of Oxford, Nuffield Department of Obstetrics & Gynecology, The Fetal Medicine Unit, Oxford, UK
| | - J Uzan-Augui
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; University Descartes Paris 5-Sorbonne Paris-Cité, 75006 Paris, France
| | - G Masselli
- Department of Radiology, University of Roma, Roma, Italy
| | - J Duan
- Department of Obstetrics & Gynecology, centre hospitalier régional universitaire de Nancy, Université de Lorraine, CIC-IT, IADI, Université de Lorraine, 54000 Nancy, France
| | - A-C Chabot-Lecoanet
- Department of Obstetrics & Gynecology, centre hospitalier régional universitaire de Nancy, Université de Lorraine, CIC-IT, IADI, Université de Lorraine, 54000 Nancy, France
| | - T Braun
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; University Descartes Paris 5-Sorbonne Paris-Cité, 75006 Paris, France; Department of Radiology, University of Roma, Roma, Italy
| | - F Chantraine
- Department of Obsterics and Gynecology, CHR Citadelle, University of Liège, Liège, Belgium
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Olsen SF, Halldorsson TI, Thorne-Lyman AL, Strøm M, Gørtz S, Granstrøm C, Nielsen PH, Wohlfahrt J, Lykke JA, Langhoff-Roos J, Cohen AS, Furtado JD, Giovannucci EL, Zhou W. Plasma Concentrations of Long Chain N-3 Fatty Acids in Early and Mid-Pregnancy and Risk of Early Preterm Birth. EBioMedicine 2018; 35:325-333. [PMID: 30082226 PMCID: PMC6156714 DOI: 10.1016/j.ebiom.2018.07.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 12/26/2022] Open
Abstract
Background Fish oil supplementation has been shown to delay spontaneous delivery, but the levels and clinical significance remain uncertain. We examined the association between plasma fatty acids quantified in pregnancy and subsequent risk of early preterm birth. Methods In a case-control design nested in the Danish National Birth Cohort, we identified 376 early preterm cases (<34 gestational weeks, excluding preeclampsia cases) and 348 random controls. Plasma eicosapentaenoic acid plus docosahexaenoic acid (EPA+DHA% of total fatty acids), were measured twice in pregnancy, at gestation weeks 9 and 25 (medians). Odds ratios and 95% confidence intervals (CI's) for associations between EPA+DHA and early preterm risk were estimated by logistic regression, adjusted for the woman's age, height, pre-pregnancy BMI, parity, smoking, and socioeconomic factors. Hypotheses and analytical plan were defined and archived a priori. Findings Analysis using restricted cubic splines of the mean of 1st and 2nd sample measurements showed a strong and significant non-linear association (p < 0.0001) in which the risk of early preterm birth steeply increased when EPA+DHA concentrations were lower than 2% and flattened out at higher levels. Women in the lowest quintile (EPA+DHA < 1.6%) had 10.27 times (95% confidence interval 6.80–15.79, p < 0.0001) increased risk, and women in the second lowest quintile had 2.86 (95% CI 1.79–4.59, p < 0.0001) times increased risk, when compared to women in the three aggregated highest quintiles (EPA+DHA ≥ 1.8%). Interpretation Low plasma concentration of EPA and DHA during pregnancy is a strong risk factor for subsequent early preterm birth in Danish women.
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Affiliation(s)
- S F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA.
| | - T I Halldorsson
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - A L Thorne-Lyman
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA; Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - M Strøm
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Faculty of Natural and Health Sciences, University of the Faroe Islands, Torshavn, Faroe Islands
| | - S Gørtz
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - C Granstrøm
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - P H Nielsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - J Wohlfahrt
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - J A Lykke
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - J Langhoff-Roos
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - A S Cohen
- Department of Congenital Diseases, Statens Serum Institut, Copenhagen, Denmark
| | - J D Furtado
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
| | - E L Giovannucci
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | - W Zhou
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China; School of Public Health, Fudan University, Shanghai, China
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5
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Vandenberghe G, Bloemenkamp K, Berlage S, Colmorn L, Deneux-Tharaux C, Gissler M, Knight M, Langhoff-Roos J, Lindqvist PG, Oberaigner W, Van Roosmalen J, Zwart J, Roelens K. The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study. BJOG 2018; 126:370-381. [PMID: 29727918 DOI: 10.1111/1471-0528.15271] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE International comparison of complete uterine rupture. DESIGN Descriptive multi-country population-based study. SETTING International. POPULATION International Network of Obstetric Survey Systems (INOSS). METHODS We merged individual data, collected prospectively in nine population-based studies, of women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes. MAIN OUTCOME MEASURES Prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section (CS) and trial of labour after CS (TOLAC). Severe maternal and perinatal morbidity and mortality. RESULTS We identified 864 complete uterine ruptures in 2 625 017 deliveries. Overall prevalence was 3.3 (95% CI 3.1-3.5) per 10 000 deliveries, 22 (95% CI 21-24) in women with and 0.6 (95% CI 0.5-0.7) in women without previous CS. Prevalence in women with previous CS was negatively correlated with previous CS rate (ρ = -0.917) and positively correlated with TOLAC rate of the background population (ρ = 0.600). Uterine rupture resulted in peripartum hysterectomy in 87 of 864 women (10%, 95% CI 8-12%) and in a perinatal death in 116 of 874 infants (13.3%, 95% CI 11.2-15.7) whose mother had uterine rupture. Overall rate of neonatal asphyxia was 28% in neonates who survived. CONCLUSIONS Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.) TWEETABLE ABSTRACT: Prevalence of complete uterine rupture is higher in countries with low previous CS and high TOLAC rates.
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Affiliation(s)
- G Vandenberghe
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - K Bloemenkamp
- Department of Obstetrics and Gynaecology, Birth Centre Wilhelmina's Children Hospital, Devision Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - S Berlage
- Centre for Quality and Management in Health Care, Medical Association of Lower Saxony, Hannover, Germany
| | - L Colmorn
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Inserm U1153, Paris Descartes University, Paris, France
| | - M Gissler
- Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - P G Lindqvist
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - W Oberaigner
- Department of Clinical Epidemiology, Tirol Kliniken Ltd., Innsbruck, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - J Van Roosmalen
- Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands.,Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - K Roelens
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
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Schaap T, Bloemenkamp K, Deneux-Tharaux C, Knight M, Langhoff-Roos J, Sullivan E, van den Akker T. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity. BJOG 2017; 126:394-401. [PMID: 28755459 DOI: 10.1111/1471-0528.14833] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Develop a core outcome set of international consensus definitions for severe maternal morbidities. DESIGN Electronic Delphi study. SETTING International. POPULATION Eight expert panels. METHODS All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. MAIN OUTCOME MEASURES Definitions with a rate of agreement of more than 70%. RESULTS The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. CONCLUSION Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. TWEETABLE ABSTRACT Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.
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Affiliation(s)
- T Schaap
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - K Bloemenkamp
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - E Sullivan
- Australian Centre for Public and Population Health Research Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - T van den Akker
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
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7
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Ingerslev MD, Langhoff-Roos J, Soegaard K, Funding E, Diness BR. Prenatal genetic testing by late amniocentesis to guide delivery management in haemophilia carriers. Haemophilia 2017; 23:e466-e468. [PMID: 28675595 DOI: 10.1111/hae.13286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2017] [Indexed: 01/21/2023]
Affiliation(s)
- M D Ingerslev
- Department of Obstetrics and Gynecology, Hvidovre University Hospital, Hvidovre, Denmark
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Holm C, Thomsen LL, Norgaard A, Langhoff-Roos J. Single-dose intravenous iron infusion or oral iron for treatment of fatigue after postpartum haemorrhage: a randomized controlled trial. Vox Sang 2017; 112:219-228. [PMID: 28198084 DOI: 10.1111/vox.12477] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the clinical efficacy of a single-dose intravenous infusion of iron isomaltoside compared with current treatment practice with oral iron measured by physical fatigue in women after postpartum haemorrhage. MATERIALS AND METHODS Single-centre, open-label, randomized controlled trial. Participants received intravenous iron (n = 97) or oral iron (n = 99), and completed the Multidimensional Fatigue Inventory and Edinburgh Postnatal Depression Scale, and haematological and iron parameters were measured. Primary outcome was the aggregated change in physical fatigue score from baseline to 12 weeks postpartum. RESULTS The difference in physical fatigue score was -0·97 (95% CI: -1·65; -0·28, P = 0·006) in favour of intravenous iron, but did not meet the predefined difference of 1·8. Across visits, we found statistically significant differences in fatigue and depression scores, as well as in haematological and iron parameters, all in favour of intravenous iron. There were no serious adverse reactions. CONCLUSION A single dose of intravenous iron was associated with a statistically significant reduction in aggregated physical fatigue within 12 weeks after postpartum haemorrhage compared to standard medical care with oral iron below the prespecified criteria of clinical superiority. As patient-reported outcomes improved significantly and intravenous iron resulted in a fast hematopoietic response without serious adverse reactions, intravenous iron may be a useful alternative after postpartum haemorrhage if oral iron is not absorbed or tolerated.
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Affiliation(s)
- C Holm
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Pharmacosmos A/S, Holbaek, Denmark
| | | | - A Norgaard
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Langhoff-Roos
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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9
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Holm C, Thomsen LL, Norgaard A, Langhoff-Roos J. Single-dose intravenous iron infusion versus red blood cell transfusion for the treatment of severe postpartum anaemia: a randomized controlled pilot study. Vox Sang 2016; 112:122-131. [PMID: 28010050 DOI: 10.1111/vox.12475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/06/2016] [Accepted: 10/12/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES There are no randomized trials comparing intravenous iron to RBC transfusion for the treatment of severe postpartum anaemia. The objectives of this study were to evaluate the feasibility of randomizing women with severe postpartum anaemia secondary to postpartum haemorrhage to RBC transfusion or intravenous iron, and to describe patient-reported outcomes, and haematological and iron parameters. MATERIALS AND METHODS Women with a postpartum haemorrhage exceeding 1000 ml and an Hb between 5·6 and 8·1 g/dl were randomized to 1500 mg of intravenous iron (n = 7) isomaltoside or RBC transfusion (n = 6). Participants completed the Multidimensional Fatigue Inventory and Edinburgh Postnatal Depression Scale, and blood samples were drawn at inclusion, daily during the first week and at weeks 3, 8 and 12. RESULTS We screened 162 women and included 13 (8%). There was no significant difference between groups in fatigue or depression scores. RBC transfusion was associated with a higher Hb on day 1, inhibition of reticulocytosis during the first week and low iron levels. Intravenous iron was associated with increased reticulocytosis during the first week, repleted iron stores and a higher Hb in weeks 3-12. CONCLUSION This pilot study shows that intravenous iron could be an attractive alternative to RBC transfusion in severe postpartum anaemia, and that a larger trial is needed and feasible.
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Affiliation(s)
- C Holm
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Pharmacosmos A/S, Holbaek, Denmark
| | | | - A Norgaard
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Langhoff-Roos
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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10
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Collins SL, Ashcroft A, Braun T, Calda P, Langhoff-Roos J, Morel O, Stefanovic V, Tutschek B, Chantraine F. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol 2016; 47:271-275. [PMID: 26205041 DOI: 10.1002/uog.14952] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/30/2015] [Accepted: 07/12/2015] [Indexed: 05/26/2023]
Affiliation(s)
- S L Collins
- The Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - A Ashcroft
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - T Braun
- Department of Obstetrics and Division of Experimental Obstetrics, Study Group Perinatal Programming, Charité Campus Virchow, Berlin, Germany
| | - P Calda
- Department of Obstetrics and Gynecology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - O Morel
- Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Nancy, France
| | - V Stefanovic
- Fetomaternal Medical Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - F Chantraine
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- University of Liège, CHR de la Citadelle, Liège, Belgium
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11
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Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadóttir RI, Tapper AM, Børdahl PE, Gottvall K, Petersen KB, Krebs L, Gissler M, Langhoff-Roos J, Källen K. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2015. [PMID: 26227006 DOI: 10.1111/1471-0528.13547.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries. DESIGN Population-based cohort study. SETTING AND POPULATION A 3-year Nordic collaboration among obstetricians to identify and report on uterine rupture, peripartum hysterectomy, excessive blood loss, and AIP from 2009 to 2012 The Nordic Obstetric Surveillance Study (NOSS). METHODS In the NOSS study, clinicians reported AIP cases from maternity wards and the data were validated against National health registries. MAIN OUTCOME MEASURES Prevalence, risk factors, antenatal suspicion, birth complications, and risk estimations using aggregated national data. RESULTS A total of 205 cases of AIP in association with laparotomy were identified, representing 3.4 per 10 000 deliveries. The single most important risk factor, which was reported in 49% of all cases of AIP, was placenta praevia. The risk of AIP increased seven-fold after one prior caesarean section (CS) to 56-fold after three or more CS. Prior postpartum haemorrhage was associated with six-fold increased risk of AIP (95% confidence interval 3.7-10.9). Approximately 70% of all cases were not diagnosed antepartum. Of these, 39% had prior CS and 33% had placenta praevia. CONCLUSION Our findings indicate that a lower CS rate in the population may be the most effective way to lower the incidence of AIP. Focused ultrasound assessment of women at high risk will likely strengthen antenatal suspicion. Prior PPH is a novel risk factor associated with an increased prevalence of AIP. TWEETABLE ABSTRACT An ultrasound assessment in women with placenta praevia or prior CS may double the awareness for AIP.
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Affiliation(s)
- L Thurn
- Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden
| | - P G Lindqvist
- Department of Obstetrics and Gynaecology, Clintec, Karolinska University Hospital, Stockholm, Sweden
| | - M Jakobsson
- Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland
| | - L B Colmorn
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - K Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - R I Bjarnadóttir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
| | - A M Tapper
- Department of Gynaecology and Paediatrics, University Hospital, Helsinki, Finland
| | - P E Børdahl
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - K Gottvall
- Department of Evaluation and Analysis, Epidemiology and Methodological support unit, National Board of Health and Welfare, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - K B Petersen
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Krebs
- Department of Obstetrics and Gynaecology, Holbaek Hospital, Holbaek and University of Copenhagen, Copenhagen, Denmark
| | - M Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Nordic School of Public Health, Gothenburg, Sweden
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - K Källen
- Department of Evaluation and Analysis, Epidemiology and Methodological support unit, National Board of Health and Welfare, Stockholm, Sweden.,Department of Reproduction Epidemiology, Tornblad Institute, Institution of Clinical Sciences, Lund University, Lund, Sweden
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Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadóttir RI, Tapper AM, Børdahl PE, Gottvall K, Petersen KB, Krebs L, Gissler M, Langhoff-Roos J, Källen K. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2015; 123:1348-55. [PMID: 26227006 DOI: 10.1111/1471-0528.13547] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries. DESIGN Population-based cohort study. SETTING AND POPULATION A 3-year Nordic collaboration among obstetricians to identify and report on uterine rupture, peripartum hysterectomy, excessive blood loss, and AIP from 2009 to 2012 The Nordic Obstetric Surveillance Study (NOSS). METHODS In the NOSS study, clinicians reported AIP cases from maternity wards and the data were validated against National health registries. MAIN OUTCOME MEASURES Prevalence, risk factors, antenatal suspicion, birth complications, and risk estimations using aggregated national data. RESULTS A total of 205 cases of AIP in association with laparotomy were identified, representing 3.4 per 10 000 deliveries. The single most important risk factor, which was reported in 49% of all cases of AIP, was placenta praevia. The risk of AIP increased seven-fold after one prior caesarean section (CS) to 56-fold after three or more CS. Prior postpartum haemorrhage was associated with six-fold increased risk of AIP (95% confidence interval 3.7-10.9). Approximately 70% of all cases were not diagnosed antepartum. Of these, 39% had prior CS and 33% had placenta praevia. CONCLUSION Our findings indicate that a lower CS rate in the population may be the most effective way to lower the incidence of AIP. Focused ultrasound assessment of women at high risk will likely strengthen antenatal suspicion. Prior PPH is a novel risk factor associated with an increased prevalence of AIP. TWEETABLE ABSTRACT An ultrasound assessment in women with placenta praevia or prior CS may double the awareness for AIP.
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Affiliation(s)
- L Thurn
- Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden
| | - P G Lindqvist
- Department of Obstetrics and Gynaecology, Clintec, Karolinska University Hospital, Stockholm, Sweden
| | - M Jakobsson
- Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland
| | - L B Colmorn
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - K Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - R I Bjarnadóttir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
| | - A M Tapper
- Department of Gynaecology and Paediatrics, University Hospital, Helsinki, Finland
| | - P E Børdahl
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - K Gottvall
- Department of Evaluation and Analysis, Epidemiology and Methodological support unit, National Board of Health and Welfare, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - K B Petersen
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Krebs
- Department of Obstetrics and Gynaecology, Holbaek Hospital, Holbaek and University of Copenhagen, Copenhagen, Denmark
| | - M Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Nordic School of Public Health, Gothenburg, Sweden
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - K Källen
- Department of Evaluation and Analysis, Epidemiology and Methodological support unit, National Board of Health and Welfare, Stockholm, Sweden.,Department of Reproduction Epidemiology, Tornblad Institute, Institution of Clinical Sciences, Lund University, Lund, Sweden
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13
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Wikkelsø A, Edwards H, Afshari A, Stensballe J, Langhoff-Roos J, Albrechtsen C, Ekelund K, Hanke G, Secher E, Sharif H, Pedersen L, Troelstrup A, Lauenborg J, Mitchell A, Fuhrmann L, Svare J, Madsen M, Bødker B, Møller A, Wikkelsø A, Edwards H, Afshari A, Stensballe J, Langhoff-Roos J, Møller AM, Albrechtsen C, Ekelund K, Hanke G, Sharif HF, Secher EL, Christensen M, Ramsing BU, Jensen-Gadegaard P, Engskov A, Wulff C, Berntsen M, Andersen KJ, Classen V, Opstrup P, Lundstrøm LH, Flindt MS, Lunde J, Pedersen LM, Troelstrup A, Lauenborg J, Lassen B, Andersson M, Winther-Olsen M, Hougaard S, Andersen C, Petersen M, Mitchell A, Fuhrmann L, Svare J, Nielsen CV, Lefort Sønderskov M, Winkel R, Johansen M, Søgaard M, Madsen MG, Bødker B, Okkels C, Berthelsen R, Elisabeth Linnet K, Stendall L, Darfeld I, Madsen M, Pedersen L. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial †. Br J Anaesth 2015; 114:623-33. [DOI: 10.1093/bja/aeu444] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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14
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Bendix JM, Hegaard HK, Bergholt T, Langhoff-Roos J. Expectant management of PPROM and major complications before planned delivery: a retrospective cohort study. J OBSTET GYNAECOL 2014; 35:570-7. [PMID: 25517017 DOI: 10.3109/01443615.2014.987114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Women with pre-term pre-labour rupture of membranes (PPROM) 22-33 weeks' gestation were included in a retrospective cohort study with a structured audit to identify risk factors of major complications following PPROM and to assess whether these complications are predictable. Of the 234 women analysed, 106 (45%) delivered within three days. Eighty-four women (36%) had at least one major complication and 45% of these complications occurred within three days. The complication rate was 64% in early PPROM before 28 weeks' gestation and 11% in late PPROM at 28 weeks' gestation or later. Nulliparous women had an increased risk of major complications (adjusted hazards ratio: 3.07 (95% confidence interval: 1.28-7.37)). The complication rates were highest in early PPROM and during the first three days after PPROM. Multiparous women with late PPROM, who do not deliver within the first three days, have the lowest risk of major complications and are suitable for home care.
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Affiliation(s)
- J M Bendix
- a Department of Gynaecology & Obstetrics , Nordsjaellands Hospital, Hillerod, University of Copenhagen , Denmark
| | - H K Hegaard
- b The Research Unit Women's and Children's Health, the Juliane Marie Centre, Rigshospitalet, University of Copenhagen , Denmark
| | - T Bergholt
- a Department of Gynaecology & Obstetrics , Nordsjaellands Hospital, Hillerod, University of Copenhagen , Denmark
| | - J Langhoff-Roos
- c Department of Obstetrics , the Juliane Marie Centre, Rigshospitalet, University of Copenhagen , Denmark
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15
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Sneider K, Langhoff-Roos J. Cerclage or cervical occlusion--what's the difference? BJOG 2014; 121:1173. [PMID: 25047488 DOI: 10.1111/1471-0528.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/28/2022]
Affiliation(s)
- K Sneider
- Centre of Clinical Research, Vendsyssel Hospital/Clinical Institute, Aalborg University, Aalborg, Denmark
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16
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Edwards H, Wikkelsø A, Afshari A, Langhoff-Roos J, Møller A, Stensballe J. P-073 Multitransfusion in relation to postpartum haemorrhage. Thromb Res 2013. [DOI: 10.1016/s0049-3848(13)70119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lykke JA, Bare LA, Olsen J, Lagier R, Arellano AR, Tong C, Paidas MJ, Langhoff-Roos J. Thrombophilias and adverse pregnancy outcomes: results from the Danish National Birth Cohort. J Thromb Haemost 2012; 10:1320-5. [PMID: 22578003 DOI: 10.1111/j.1538-7836.2012.04773.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inherited thrombophilias have inconsistently been linked to adverse pregnancy outcomes. Differences in study design, size and population could explain this heterogeneity. OBJECTIVE The aim of the present study was to evaluate if factor (F)V Leiden G1691A, prothrombin mutation G20210A (PTM) and methylenetetrahydrofolate reductase C677T (MTHFR) increased the risk of severe preeclampsia, fetal growth restriction, very preterm delivery, placental abruption and a composite of these outcomes also including stillbirth. PATIENTS AND METHODS In a nested case-cohort study of pregnant women in Denmark, we genotyped 2032 cases and 1851 random controls. Each of the medical records of the cases was validated. We calculated both genomic and allelic models, and present both models. We also performed sensitivity analyses adjusting for parity, age, smoking, body mass index and socioeconomic status. RESULTS In the allelic models, FV Leiden increased the risk of the composite outcome (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.1-1.8), severe preeclampsia (OR 1.6, 95% CI 1.1-2.4), fetal growth restriction (OR 1.4, 95% CI 1.1-1.8) and placental abruption (OR = 1.7 (95% CI 1.2-2.4). In the sensitivity analyses, adjustment diminished these estimates slightly. PTM was not significantly associated with any of the outcomes, and MTHFR was only significantly associated with severe preeclampsia (OR 1.3, 95% CI 1.1-1.6). CONCLUSION FV Leiden predisposes to adverse pregnancy outcomes in a setting of Scandinavian women.
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Affiliation(s)
- J A Lykke
- Department of Obstetrics and Gynecology, Roskilde Hospital, Roskilde, Denmark.
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20
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Abstract
OBJECTIVE To examine the association between intended mode of delivery and severe postpartum haemorrhage. DESIGN A retrospective cohort study. SETTING Material from a nationwide study in Denmark. POPULATION Danish women giving birth in 2001-08. METHODS We compared use of red blood cell transfusion by intended mode of delivery in the total population (n = 382 266), in low-risk nulliparous women (n = 147 132) and in women with a previous caesarean delivery (n = 25 156). MAIN OUTCOME MEASURE Red blood cell transfusion within 7 days of delivery. RESULTS In the total population the crude transfusion rates for women with planned caesarean delivery and intended vaginal delivery were 2.24 and 1.75%. After adjustment for maternal age, body mass index, birthweight, smoking, parity, number of infants and previous caesarean delivery, the risk of red blood cell transfusion was significantly lower in women with planned caesarean delivery compared with intended vaginal delivery (odds ratio 0.82; 95% CI 0.73-0.92; P < 0.01). In low-risk nulliparous women and in women with a previous caesarean delivery the transfusion rates were lower for planned caesarean delivery compared with intended vaginal delivery before and after adjustment. CONCLUSION Compared with intended vaginal delivery, planned caesarean delivery was associated with a reduced risk of severe postpartum haemorrhage indicated by use of red blood cell transfusion.
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Affiliation(s)
- C Holm
- Department of Obstetrics, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
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21
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Lykke JA, Paidas MJ, Damm P, Triche EW, Kuczynski E, Langhoff-Roos J. Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the mother. BJOG 2009; 117:274-81. [PMID: 20015308 DOI: 10.1111/j.1471-0528.2009.02448.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Preterm delivery has been shown to be associated with subsequent maternal cardiovascular morbidity. However, the impact of the severity and recurrence of preterm delivery on the risk of specific cardiovascular events and the metabolic syndrome in the mother, have not been investigated. DESIGN National registry-based retrospective cohort study. SETTING Women delivering in Denmark from 1978 to 2007. POPULATION Women with a first singleton delivery (n = 782 287), and with a first and second singleton delivery (n = 536 419). METHODS Cox proportional hazard models, with the gestational age stratified into four groups as primary exposure. We made adjustments for maternal age, year of delivery, hypertensive pregnancy disorders, fetal growth deviation, placental abruption and stillbirth. MAIN OUTCOME MEASURES Subsequent maternal hypertension, ischaemic heart diseases, thromboembolism and type-II diabetes. RESULTS After a first delivery at 32-36 completed weeks of gestation, the adjusted risk of subsequent type-II diabetes increased 1.89-fold (1.69-2.10) and the risk of thromboembolism increased 1.42-fold (1.24-1.62). Women having a preterm delivery in the first pregnancy and a term delivery in the second had a 1.58-fold (1.34-1.86) increased risk of type-II diabetes and a 1.18-fold (0.96-1.44) increased risk of thromboembolism. Women having two preterm deliveries had a 2.30-fold (1.71-3.10) increased risk of type-II diabetes and a 1.80-fold (1.29-2.50) increased risk of thromboembolism. CONCLUSIONS Preterm delivery is independent of other pregnancy complications associated with subsequent maternal overt type-II diabetes and thromboembolism. The recurrence of preterm delivery will augment these risks.
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Affiliation(s)
- J A Lykke
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark.
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22
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Richardus JH, Graafmans WC, Bergsjø P, Lloyd DJ, Bakketeig LS, Bannon EM, Borkent-Polet M, Davidson LL, Defoort P, Leitão AE, Langhoff-Roos J, Garcia AM, Papantoniou NE, Wennergren M, Amelink-Verburg MP, Verloove-Vanhorick SP, Mackenbach JP. Suboptimal care and perinatal mortality in ten European regions: methodology and evaluation of an international audit. J Matern Fetal Neonatal Med 2009; 14:267-76. [PMID: 14738174 DOI: 10.1080/jmf.14.4.267.276] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results. METHODS Perinatal deaths between 1993 and 1998 in regions of ten European countries were identified. The categories of death chosen for the study were singleton fetal deaths at 28 or more weeks of gestational age, all intrapartum deaths at 28 or more weeks of gestational age and neonatal deaths at 34 or more weeks of gestational age. Deaths with major congenital anomalies were excluded. An international audit panel used explicit criteria to review all cases, which were blinded for region. Subjective interpretation was used in cases of events or interventions where explicit criteria did not exist. Suboptimal factors were identified in the antenatal, intrapartum and neonatal periods, and classified as 'maternal/social', due to 'infrastructure/service organization', or due to 'professional care delivery'. The contribution of each suboptimal factor to the fatal outcome was listed and consensus was reached on a final grade using a procedure that included correspondence and plenary meetings. RESULTS In all regions combined, 90% of all known or estimated cases in the selected categories were included in the audit. In total, 1619 cases of perinatal death were audited. Consensus was reached in 1543 (95%) cases. In 75% of all cases, the grade was based on explicit criteria. In the remaining cases, consensus was reached within subpanels without reference to predefined criteria. There was reasonable to good agreement between and within subpanels, and within panel members. CONCLUSIONS The international audit procedure proved feasible and led to consistent results. The results that relate to suboptimal care will need to be studied in depth in order to reach conclusions about their implications for assessing the quality of perinatal care in the individual regions.
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Affiliation(s)
- J H Richardus
- Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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23
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Ekelund CK, Vogel I, Skogstrand K, Thorsen P, Hougaard DM, Langhoff-Roos J, Jacobsson B. Interleukin-18 and interleukin-12 in maternal serum and spontaneous preterm delivery. J Reprod Immunol 2007; 77:179-85. [PMID: 17850880 DOI: 10.1016/j.jri.2007.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 06/30/2007] [Accepted: 07/12/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Mice disrupted for the interleukin (IL)-18 gene appear more disposed to preterm delivery (PTD) induced by inflammation. A synergy between IL-18 and IL-12 has been suggested. The objective of this study was to investigate a possible relation between human maternal serum levels of IL-18, IL-12 and spontaneous PTD. MATERIALS AND METHODS A cohort of 93 consecutive women with symptoms of threatening PTD on admission was enrolled at the delivery ward, Aarhus University Hospital, Denmark. MEASURES Serum IL-18 and IL-12 measured using Luminex xMAP technology. Endpoint: PTD before 34 weeks gestation. RESULTS Pregnant women admitted with symptoms of threatening PTD and delivering before 34 weeks of gestation had significantly lower levels of IL-18 compared to women delivering at or after 34 weeks of gestation (medians: 14.5 versus 26.6 pg/ml; p=0.035). IL-12 levels were not different in women delivering before or after 34 weeks of gestation. Patients having low IL-18 (below the 25-percentile) and high IL-12 (above the 75-percentile) had a twofold increase in risk of delivering before 34 weeks of gestation (RR 2.1 [1.7-2.6]). CONCLUSION Results from this study indicate, that low serum IL-18 level could be associated with PTD in women with symptoms of PTD. A possible interaction between IL-18 and IL-12 was found, as the risk of delivering before 34 weeks is increased with the combination of low IL-18 and high IL-12, but further studies are warranted to investigate these interleukins and their possible role in PTD.
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Affiliation(s)
- C K Ekelund
- North Atlantic Neuro-Epidemiology Alliances, Institute of Public Health, University of Aarhus, Vennelyst Boulevard 6, DK-8000 Aarhus, Denmark.
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Winter C, Macfarlane A, Deneux-Tharaux C, Zhang WH, Alexander S, Brocklehurst P, Bouvier-Colle MH, Prendiville W, Cararach V, van Roosmalen J, Berbik I, Klein M, Ayres-de-Campos D, Erkkola R, Chiechi LM, Langhoff-Roos J, Stray-Pedersen B, Troeger C. Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe. BJOG 2007; 114:845-54. [PMID: 17567419 PMCID: PMC1974828 DOI: 10.1111/j.1471-0528.2007.01377.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2007] [Indexed: 01/15/2023]
Abstract
BACKGROUND The EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System (EUPHRATES) is a set of five linked projects, the first component of which was a survey of policies for management of the third stage of labour and immediate management of postpartum haemorrhage following vaginal birth in Europe. OBJECTIVES The objectives were to ascertain and compare policies for management of the third stage of labour and immediate management of postpartum haemorrhage in maternity units in Europe following vaginal birth. DESIGN Survey of policies. SETTING The project was a European collaboration, with participants in 14 European countries. SAMPLE All maternity units in 12 countries and in selected regions of two countries in Europe. METHODS A postal questionnaire was sent to all or a defined sample of maternity units in each participating country. MAIN OUTCOME MEASURES Stated policies for management of the third stage of labour and the immediate management of postpartum haemorrhage. RESULTS Policies of using uterotonics for the management of the third stage were widespread, but policies about agents, timing, clamping and cutting the umbilical cord and the use of controlled cord traction differed widely. For immediate management of postpartum haemorrhage, policies of massaging the uterus were widespread. Policies of catheterising the bladder, bimanual compression and in the choice of drugs administered were much more variable. CONCLUSIONS Considerable variations were observed between and within countries in policies for management of the third stage of labour. Variations were observed, but to a lesser extent, in policies for the immediate management of postpartum haemorrhage after vaginal birth. In both cases, policies about the pharmacological agents to be used varied widely.
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Affiliation(s)
- C Winter
- School of Nursing and Midwifery, University of DundeeDundee, UK
| | - A Macfarlane
- Department of Midwifery, City UniversityLondon, UK
| | | | - W-H Zhang
- Perinatal Epidemiology Research Unit, Université Libre de BruxellesBrussels, Belgium
| | - S Alexander
- Perinatal Epidemiology Research Unit, Université Libre de BruxellesBrussels, Belgium
| | | | | | - W Prendiville
- Department of Obstetrics and Gynaecology, Royal College of Surgeons of Ireland, Coombe HospitalDublin, Ireland
| | - V Cararach
- Hospital Clínic, IDIBAPS, University of BarcelonaBarcelona, Spain
| | | | - I Berbik
- Hungarian Society of Obstetrics and GynaecologyBudapest, Hungary
| | - M Klein
- Hanusch-Krankenhaus Gynakolog, University of ViennaVienna, Austria
| | | | - R Erkkola
- University Central Hospital of TurkuTurku, Finland
| | - LM Chiechi
- Unita di Obstetrica e gynecologia policlinica, University of BariBari, Italy
| | - J Langhoff-Roos
- Department of Obstetrics and Gynaecology, University of CopenhagenCopenhagen, Denmark
| | | | - C Troeger
- Pränatale Medizin, Universitäts FrauenklinikBasel, Switzerland
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Abstract
OBJECTIVES To evaluate and compare the three most commonly used perinatal death classification systems: (1) the Nordic-Baltic; (2) the Aberdeen; and (3) the Wigglesworth, and assess their applicability in a developing country (Sudan) with a high perinatal mortality rate, and their justification for practical use in quality assurance and audit activities. METHODS At Omdurman Maternity Hospital (OMH), Khartoum, Sudan, 166 perinatal deaths were prospectively assessed during a 3-month period (May-August 2000) with a total of 2260 births. Narratives of 166 perinatal deaths were prepared for the purpose of audit. A panel of two Danish and one Sudanese obstetrician categorized the cases according to: (1) the Nordic-Baltic; (2) the Aberdeen; and (3) the Wigglesworth classification. RESULTS By all three classifications a similar fraction of cases (approx. 85%) were allocated to one category only, and in 15% of cases the assessors were in doubt into which of two categories the cases should be allocated. The necessary information is often not available, giving at least 40% classified as 'unknown' in the Aberdeen classification, whereas the Wigglesworth classification results in an even larger group of unspecified asphyxia. CONCLUSION Classification of perinatal deaths in developing countries is associated with problems regarding application, validity and usefulness. The Nordic-Baltic classification seems to be most suitable for appropriate stratification using routinely recorded variables and providing categories associated with specific levels of care.
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Affiliation(s)
- S Elamin
- Copenhagen University, Rigshospitalet, Denmark.
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Krebs L, Langhoff-Roos J, Thorngren-Jerneck K. Long-term outcome in term breech infants with low Apgar score--a population-based follow-up. Eur J Obstet Gynecol Reprod Biol 2001; 100:5-8. [PMID: 11728648 DOI: 10.1016/s0301-2115(01)00456-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the relation between low Apgar score in breech infants and handicap in childhood. STUDY DESIGN A case-control study. A questionnaire to mothers of 323 non-malformed, singleton infants delivered in breech presentation at term, 105 cases with Apgar score below 7 at 5 min and 218 controls. RESULTS Four cases (4.6%) and one control (0.5%) had cerebral palsy. In infants without cerebral palsy, speech/language problems were more frequent than controls (10.6 versus 3.2%) (P=0.02). There were no differences in rates of deficits in attention, motor control and perception (DAMP), epilepsy, cognitive developmental delay or learning disabilities. Absence of any handicap or disability was reported in 65 cases (75%) compared to 172 controls (92%) (OR: 3.9; 95% CI: 1.9-7.9). CONCLUSION Even though low Apgar score indicates an increased risk of neurological sequelae, most (75%) breech infants with low Apgar score are without a handicap/disability at follow-up.
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Affiliation(s)
- L Krebs
- Department of Obstetrics, 4031 Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark.
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27
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Abstract
OBJECTIVE A national audit on perinatal deaths was performed to assess the quality of antenatal care, and to suggest measures for improved antenatal care. MATERIAL AND METHODS Medical records of all the perinatal deaths in Latvia in the years 1995-1996 have been studied. Non-attenders and attenders of antenatal care were characterized by socio-economic and medical variables: maternal age, parity, history of perinatal outcome, health status and behavioral hazards during the index pregnancy, length of gestation and birth weight. The Nordic-Baltic perinatal death classification was used. RESULTS In 85 of 442 cases (19%) of perinatal deaths women had not taken advantage of antenatal care provided for them. Non-attenders were more likely to be smokers (p<0.001) and alcohol abusers (p<0.005), above 35 years of age (p<0.005), and had higher parity (p<0.001). Non-attenders more often had systemic diseases and pregnancy complications. Neonatal complications, such as congenital syphilis (p<0.05) and other infections (p<0.05), were more common among non-attenders. There was no difference in rates of preterm birth and low birth weight between attenders and non-attenders. CONCLUSIONS One fifth of mothers with perinatal death did not attend ANC, and in some women who attended ANC, lack of intervention was related to the perinatal death.
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Affiliation(s)
- M Jansone
- Department of Obstetrics and Gynecology, Medical Academy of Latvia, Riga, Latvia
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Westergaard HB, Langhoff-Roos J, Lingman G, Marsál K, Kreiner S. A critical appraisal of the use of umbilical artery Doppler ultrasound in high-risk pregnancies: use of meta-analyses in evidence-based obstetrics. Ultrasound Obstet Gynecol 2001; 17:466-476. [PMID: 11422966 DOI: 10.1046/j.1469-0705.2001.00415.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To reanalyze randomized controlled trials on the use of umbilical artery Doppler velocimetry in high-risk pregnancies and determine which high-risk pregnancies benefit from the use of Doppler velocimetry. METHODS Searching Medline, the Cochrane Library and Embase we found 13 randomized controlled trials on the use of Doppler velocimetry in high-risk pregnancies. Of these, six included pregnancies with strictly defined suspected intrauterine growth restriction and/or hypertensive disease of pregnancy ('well-defined studies'); the rest included a great variety of high-risk pregnancies ('general risk studies'). The studies were analyzed with particular regard to the heterogeneity and to outcome. Audits of the perinatal deaths reported in the randomized controlled trials were performed by a panel of 32 international experts. RESULTS The 'well-defined studies' had a more uniform study design as compared to the 'general risk studies' and they showed a significant reduction in antenatal admissions (odds ratio, 0.56; 95% confidence interval, 0.43-0.72), inductions of labor (0.78; 0.63-0.96), elective deliveries (inductions of labor and elective Cesarean sections) (0.73; 0.61-0.88) and Cesarean sections (0.78; 0.65-0.94). By perinatal audit it was found that more perinatal deaths in the 'well-defined studies' were potentially avoidable by use of Doppler velocimetry ( P < 0.0005) and the rate of avoidable perinatal deaths was higher among controls (50%) than cases (20%) in this group. CONCLUSION The randomized controlled trials on umbilical artery Doppler velocimetry show major differences regarding study design and technical and clinical issues and, therefore, they should not be pooled in a simple meta-analysis. By stratification it was found that only in pregnancies with suspected intrauterine growth restriction and/or hypertensive disease of pregnancy will the use of umbilical artery Doppler velocimetry reduce the number of perinatal deaths and unnecessary obstetric interventions.
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Affiliation(s)
- H B Westergaard
- Copenhagen University Hospital, Department of Obstetrics and Gynecology, Denmark.
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Abstract
OBJECTIVE To determine whether the conduct of the second stage of labor and delivery technique influences the incidence of rupture of the anal sphincter. MATERIAL AND METHOD A total of 1072 primipara delivered vaginally at term at Rigshospitalet in 1998. A questionnaire on prenatal risk factors, conduct of the second stage of labor, and delivery technique was completed by the attending midwife immediately after delivery in 90 cases with rupture of the sphincter and in two subsequent controls (n = 164), matched by use of vacuum extractor and episiotomy. RESULTS Partial or total sphincter rupture was found in 8.4% of primipara who delivered vaginally, in 20.9% of those delivered by vacuum extraction, and in 6.4% of those with episiotomy only. The prenatal risk factors--maternal age, birth weight, shoulder dystocia, and edema of the perineum were found to have a statistically significant effect on the incidence of rupture of the sphincter ani. In non-instrumental vaginal deliveries easing of the perineum over the caput as it advanced helped prevent a rupture of the anal sphincter. Vacuum extraction performed with the woman in a semi-recumbant position was associated with an increased risk of rupture of the anal sphincter, whereas attention to the perineum during extraction decreased the risk. CONCLUSIONS The significant effect of prenatal risk factors did not explain a correlation between delivery technique and rupture of the sphincter ani. The present study indicates that a reduction in the incidence of sphincter rupture may be accomplished by improved obstetric care: fewer vacuum extractions and improved delivery technique.
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Affiliation(s)
- C Parnell
- Obstetric Department, Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark.
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Elamin S, Langhoff-Roos J, Bødker B, Larsen S, Ibrahim S, Ashmeig A, Lindmark G. Perinatal audit in Sudan. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)82706-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Boedker B, Mogilevkina I, Langhoff-Roos J, Larsen S, Lindmark G, Orda A. Perinatal deaths in the Donetsk region, Ukraine and in Denmark. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)82698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Pamell C, Langhoff-Roos J, Moller H. Conduct of labor and rupture of the sphincter ANI. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)82682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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33
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Westergaard H, Langhoff-Roos J, Lingman G, Marsál K. The evidence for using doppler ultrasound in high-risk pregnancies - a re-analysis seen from the view of a health technology assessment (HTA). Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)82040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Krebs L, Langhoff-Roos J. The relation of breech presentation at term to epilepsy in childhood. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)82420-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Abstract
The aim of the study was to determine the influence of intended mode of delivery on neonatal outcome in term breech delivery and to identify risk factors at intended vaginal delivery. Based on register data on all deliveries of non-malformed, singleton fetuses in breech presentation at term (n = 19,476) in Denmark, 1982-92, a review of medical records of all (n = 218) cases with Apgar score < 7 at 5 minutes, including intrapartum and early neonatal deaths and 412 controls, was performed. Planned vaginal delivery was associated with a 15 times greater risk of low Apgar score than elective Caesarean section. Low Apgar score was correlated with duration of second stage of labour, but not with age, parity, birthweight, induction, augmentation or duration of first stage of labour. In conclusion, a pre-labour decision on vaginal delivery was associated with a 15-fold increase in low Apgar score. Prediction of low Apgar score in women selected for vaginal delivery does not seem possible before the second stage of labour.
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Affiliation(s)
- L Krebs
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark.
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36
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Abstract
OBJECTIVE To examine the relation between breech delivery and cerebral palsy, considering the influence of intrauterine growth, low Apgar score at birth, and mode of delivery. DESIGN Register-based, case-control study. POPULATION A cohort of infants with cerebral palsy born between 1979 and 1986 in East Denmark, identified by linkage of the cerebral palsy register with the national birth register. Discharge letters from births of breech infants with cerebral palsy were reviewed. MAIN OUTCOME MEASURES Presentation, mode of delivery, gestational age, birthweight, Apgar score, type of cerebral palsy, severity of handicap. RESULTS Breech presentation at term was associated with a borderline significantly higher risk of cerebral palsy than vertex presentation (OR 1.56; 95% CI 0.9-2.4). Breech presentation infants more often had a lower Apgar score (< 7 at 5 minutes) and were smaller for gestational age (SGA < 2 SD) than were those with vertex presentation; infants with a low Apgar score, or who were small for gestational age, had a higher risk of cerebral palsy. After stratification by being small for gestational age the risk of cerebral palsy was not related to presentation. There were no differences between breech and vertex infants with cerebral palsy in terms of low Apgar score, being small for gestational age, mode of delivery, and severity of the handicap. Breech presentation infants were more often classified as diplegic (77.8% versus 42.3% in cephalic infants). CONCLUSION The risk of cerebral palsy among term breech presentation infants does not seem to be related to mode of delivery, but is more likely linked to a higher rate of being small for gestational age in breech infants.
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Affiliation(s)
- L Krebs
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark
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37
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Philipsen JP, Lorentzen U, Lauenborg J, Langhoff-Roos J, Hornnes PJ. [Implementation of evidence-based technique in Cesarean section]. Ugeskr Laeger 1999; 161:3855-8. [PMID: 10412307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- J P Philipsen
- H:S Rigshospitalet, Juliane Marie Centret, obstetrisk klinik
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38
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Langhoff-Roos J, Larsen S, Basys V, Lindmark G, Badokynote M. Potentially avoidable perinatal deaths in Denmark, Sweden and Lithuania as classified by the Nordic-Baltic classification. Br J Obstet Gynaecol 1998; 105:1189-94. [PMID: 9853768 DOI: 10.1111/j.1471-0528.1998.tb09973.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To analyse which subgroups of perinatal deaths contribute most to the perinatal mortality rate in Lithuania compared with Denmark/Sweden. DESIGN Comparison of all perinatal deaths in Denmark/Sweden 1991 and Lithuania 1993-1994 by the common Nordic-Baltic perinatal death classification, based on information from the medical records. RESULTS The doubled perinatal mortality in Lithuania compared with Denmark/Sweden is mainly explained by a threefold increase of intrapartum and two- to fivefold increase in neonatal deaths of nonmalformed infants. The higher rate of malformed infants is partly explained by a four times higher mortality from neural tube defects. CONCLUSIONS The use of a common perinatal death classification has identified categories mainly responsible for the higher rate of perinatal mortality, but further investigation of potentially avoidable factors requires further study.
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Affiliation(s)
- J Langhoff-Roos
- Department of Obstetrics and Gynaecology, Rigshospitalet, Copenhagen, Denmark
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39
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Kristensen J, Langhoff-Roos J, Kristensen FB. [Significance of idiopathic preterm birth in relation to previous and future pregnancies]. Ugeskr Laeger 1998; 160:3732-5. [PMID: 9641060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This registry-based cohort study aimed to describe the relationship between pregnancy complications in the first and second pregnancy, focussing on idiopathic and indicated preterm birth of singleton infants in either pregnancy. The cohort consisted of all women living in Denmark with a first singleton birth in 1982 and a second in the period 1982-1987 (13,967 women). The risk of a second preterm birth was not significantly different between women who had an idiopathic or an indicated first preterm birth (15.2 and 12.8% respectively). Adjustment by logistic regression analysis for other risk factors for preterm birth did not influence the relative risk (6.0 before 32 weeks and 4.8 between 32 and 36 weeks) of a second preterm birth subsequent to a first one. Women with idiopathic preterm delivery in their first or second pregnancies give birth to infants with lower birth weight in previous or subsequent pregnancies. Emergency cesarean section in a first term pregnancy was a risk factor for subsequent idiopathic preterm birth.
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Affiliation(s)
- J Kristensen
- H:S Rigshospitalet, Juliane Marie Centret, føde- og gynaekologisk afdeling
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40
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Lorentzen U, Philipsen JP, Langhoff-Roos J, Hornnes PJ. [Surgical technique in Cesarean section. Evidence or tradition?]. Ugeskr Laeger 1998; 160:2517-20. [PMID: 9599531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The literature was reviewed in order to find clinical-epidemiological and physiological evidence for which surgical techniques should be preferred when performing Caesarean section. We found reasonable evidence for the following procedure: spontaneous placenta detachment, uterine repair in one layer and non-closure of the peritoneum.
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Affiliation(s)
- U Lorentzen
- H:S Rigshospitalet, Juliane Marie Center, obstetrisk klinik
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41
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Svare JA, Langhoff-Roos J. [Antibiotic treatment in threatened preterm labor]. Ugeskr Laeger 1998; 160:2235-7. [PMID: 9599517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J A Svare
- Gynaekologisk-obstetrisk afdeling, Amtssygehuset i Glostrup
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42
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Westergaard HB, Langhoff-Roos J, Larsen S, Borch-Christensen H, Lindmark G. Intrapartum death of nonmalformed fetuses in Denmark and Sweden in 1991. A perinatal audit. Acta Obstet Gynecol Scand 1997; 76:959-63. [PMID: 9435736 DOI: 10.3109/00016349709034909] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In 1991 the rate of intrapartum death of non-malformed fetuses was higher in Denmark than in Sweden (4.2 vs. 1.9 per 10,000, OR 2.24). However, it is not clear whether this difference reflects potentially avoidable cases and/or suboptimal care. MATERIAL AND METHODS Short descriptions were made from medical records of all 50 intrapartum deaths in Denmark and Sweden in 1991. Ten obstetricians, two from each of the Nordic countries, reviewed the cases to determine whether (1) intra-uterine death might have occurred before admission, (2) surveillance and intervention were insufficient, (3) fetal death was potentially avoidable by improved obstetric care; and, if so, to suggest ways of improved health care. RESULTS There was a statistically higher rate of insufficient care (surveillance and intervention) (high or less degree) in the Danish cases (66% vs. 55%). The proportion of potentially avoidable fetal deaths was also higher in Denmark (59% vs. 52%) although the difference was not statistically significant. CONCLUSION The significantly higher rate of intrapartum death of non-malformed infants in 1991 in Denmark compared to Sweden might be reduced by improved intrapartum surveillance and interventions.
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Topp M, Langhoff-Roos J, Uldall P. Preterm birth and cerebral palsy. Predictive value of pregnancy complications, mode of delivery, and Apgar scores. Acta Obstet Gynecol Scand 1997; 76:843-8. [PMID: 9351410 DOI: 10.3109/00016349709024363] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Preterm infants are at 8 times higher risk than term infants for pre- and perinatal brain damage, resulting in cerebral palsy. In this paper we have analysed the influence of prenatal and birth-related risk factors on cerebral palsy in preterm infants. METHODS In a register-based study, 175 preterm singleton infants with cerebral palsy, born in 1982-86, were compared with 687 controls matched by gestational age and year of birth. RESULTS Statistically significant higher rates in cases were found in parity > or = 3 (22% vs. 16%, p < 0.05), Cesarean section (67% vs. 56%, p < 0.01), and low Apgar scores at 1 minute (45% vs. 36%, p < 0.05). By multivariate analyses, two variables remained statistically significant: parity > or = 3 (adjusted OR = 1.53 (95% CI 1.00-2.34), p < 0.05) and Cesarean section (adjusted OR = 1.57 (95% CI 1.07-2.32), p < 0.05). CONCLUSIONS Pregnancy complications preceding preterm birth did not imply a higher risk of cerebral palsy. Delivery by Cesarean section was a prognostic factor for developing cerebral palsy, and the predictive value of Apgar scores was highly limited.
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Affiliation(s)
- M Topp
- Department of Obstetrics and Gynecology, University of Copenhagen, Hvidovre Hospital, Denmark
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Abstract
To investigate changes in cerebral palsy birth prevalence and perinatal mortality rate by different gestational age groups, 1979-86, cerebral palsy cases in eastern Denmark were identified from the Danish Cerebral Palsy Register, and information on birth and mortality rates was sought in the Danish Medical Birth Register. From 1979-82 to 1983-86, the birth prevalence of cerebral palsy increased from 2.6 to 3.0 per 1000 (P < 0.05). The rate for infants of 31 weeks' gestation or more did not change, whereas a significant increase was observed in infants below 31 weeks (85-123 per 1000, P < 0.05). In the same periods, perinatal mortality in eastern Denmark decreased significantly from 8.6 to 7.8 per 1000. The decrease in stillbirth rate was significant in all subgroups of gestational ages except in those of 28-30 weeks' gestation. The early neonatal mortality rate decreased significantly only in infants below 31 weeks (282-239 per 1000, P < 0.05). Thus, in eastern Denmark, cerebral palsy birth prevalence has increased from birth-year period 1979-82 to 1983-86 because of an increased rate in preterm infants below 31 weeks, who at the same time had a reduced risk of early neonatal death.
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Affiliation(s)
- M Topp
- Cerebral Palsy Registry in Denmark, Danish Institute for Clinical Epidemiology, Denmark
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45
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Langhoff-Roos J, Larsen S, Borch-Christensen H, Lindberg B, Wennergren M. [Potentially avoidable perinatal deaths in Denmark and Sweden 1991]. Ugeskr Laeger 1997; 159:5378-82. [PMID: 9304269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In 1991 the perinatal mortality rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries to some extent could reflect differences in the quality of care. Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing on potential avoidability from a health services perspective was elaborated at a Nordic-Baltic workshop, using the variables: time of death in relation to admission and delivery, fetal malformation, gestational age, growth-retardation and Apgar score at 5 min. Rates of perinatal deaths of malformed infants (0.00195 and 0.00145) and intrapartum deaths of non-malformed infants (0.00042 and 0.00019) were significantly higher in Denmark than in Sweden. The study raised the following questions: why is the rate of perinatal death of malformed infants higher in Denmark than in Sweden and could intrapartum care in Denmark be improved?
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Abstract
OBJECTIVES To analyse completeness and validity of data in the Cerebral Palsy Register in Denmark, 1979-1982. METHODS Completeness has been assessed by comparing data from The Danish National Patient Register (DNPR) with the cases included in the Cerebral Palsy Register (CPR). Agreement between 12 variables in the CPR and obstetrical medical records has been analysed using kappa-statistics. RESULTS Of 468 children in the DNPR, only 237 fulfilled the inclusion criteria of the CPR; and 35 (15%) of these cases had not been reported to the CPR. Data agreement was generally good, but gestational age was subject to a systematic error, and urinary infections in pregnancy (kappa = 0.43) and placental abruption (kappa = 0.52) were seriously under-reported in the CPR. CONCLUSIONS Completeness of the Cerebral Palsy Register in Denmark, 1979-1982, has been assessed to maximal 85%, emphasizing the impact of using supplementary case ascertainment sources in the future. Validity of data varied according to definition and significance of the specific variable.
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Affiliation(s)
- M Topp
- Department of Obstetrics and Gynecology 537, Hvidovre Hospital, Denmark
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47
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Svare J, Langhoff-Roos J, Andersen LF, Kryger-Baggesen N, Borch-Christensen H, Heisterberg L, Kristensen J. Ampicillin-metronidazole treatment in idiopathic preterm labour: a randomised controlled multicentre trial. Br J Obstet Gynaecol 1997; 104:892-7. [PMID: 9255079 DOI: 10.1111/j.1471-0528.1997.tb14347.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine whether treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour will prolong the gestation and reduce maternal and neonatal infectious morbidity. DESIGN Randomised controlled double-blind trial. SETTING Six obstetric departments in the Copenhagen area. POPULATION One hundred and twelve women with singleton pregnancies, with threatened idiopathic preterm labour and intact amniotic membranes at 26 to 34 weeks of gestation. METHODS Random allocation to eight days intravenous and oral treatment with ampicillin and metronidazole, or placebo. MAIN OUTCOME MEASURES Number of days from admission to delivery, gestational age at delivery, rates of preterm delivery, low birthweight, maternal infections and neonatal infections. RESULTS Treatment with ampicillin and metronidazole was associated with a significant prolongation of pregnancy (admission to delivery 47.5 days versus 27 days, P < 0.05), higher gestational age at delivery (37 weeks versus 34 weeks, P < 0.05), decreased incidence of preterm birth (42% versus 65%, P < 0.05), and lower rate of admission to neonatal intensive care unit (40% versus 63%, P < 0.05), when compared with placebo treatment. Antibiotic treatment had no significant effects on infectious morbidity. CONCLUSIONS Treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour significantly prolonged the gestation, but had no effects on maternal and neonatal infectious morbidity.
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Affiliation(s)
- J Svare
- Department of Obstetrics and Gynaecology, Rigshospitalet Copenhagen, Denmark
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48
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Krebs L, Nilas L, Langhoff-Roos J, Pedersen BL. [Breech delivery. Selection by X-ray pelvimetry]. Ugeskr Laeger 1997; 159:2697-701. [PMID: 9173634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
An attempt was made to evaluate the possible benefit of selecting women for vaginal breech delivery at term by radiological pelvimetry. Information from medical records on 276 singleton breech deliveries were analysed. A total of 188 breech presentations were diagnosed before the onset of labour, pelvimetry was performed in 74 women, where pelvic dimensions too small for recommendation of vaginal breech delivery were found in 30 cases. The overall rate of caesarean section was 78%, among diagnosed patients it was 84% and 64% among undiagnosed breech presentations. Rates of morbidity (low Apgar score and admission to the neonatal care unit) did not differ significantly between infants delivered vaginally or by elective caesarean section. The material, however, is too small for valid conclusions regarding safety of vaginal delivery of term breech in women selected by criteria including estimate of pelvic size.
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Affiliation(s)
- L Krebs
- Hyidovre Hospital, gynaekologisk-obstetrisk afdeling
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49
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Krebs L, Langhoff-Roos J, Hornnes PJ. [Breech presentation, vaginal delivery or cesarean section--a review article?]. Ugeskr Laeger 1997; 159:2240-1. [PMID: 9148553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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50
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Borch-Christensen H, Langhoff-Roos J, Larsen S, Lindberg B, Wennergren M. The Nordic/Baltic perinatal death classification. Acta Obstet Gynecol Scand Suppl 1997; 164:40-2. [PMID: 9225635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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